Provider Demographics
NPI:1619010709
Name:STANLEY GLICK, LCSW, BCD, P.C.
Entity Type:Organization
Organization Name:STANLEY GLICK, LCSW, BCD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:215-321-1435
Mailing Address - Street 1:412 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8003
Mailing Address - Country:US
Mailing Address - Phone:215-321-1435
Mailing Address - Fax:215-369-8258
Practice Address - Street 1:412 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8003
Practice Address - Country:US
Practice Address - Phone:215-321-1435
Practice Address - Fax:215-369-8258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000778L1041C0700X
NJ44SC000789001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA109431Medicare PIN
NJ107649Medicare PIN